How to measure mental health in the general population? Reiner Rugulies

Transcription

1 How to measure mental health in the general population? Reiner Rugulies National Research Centre for the Working Environment, Denmark Department of Public Health and Department of Psychology, University of Copenhagen, Denmark Medlemsmøde I Dansk Selbskab for Psykosocial Medicine, København, 24. januar 2012

2 Why we need good meas urements of mental health in public health re search To determine the prevalence of speci fic mental disorders in the whole population and in subgroups e.g., unipolar depression, anxiety, somatoform disorders, substance abuse To analyse whether specific exposures predict onset of specific mental disorders e.g., socioeconomic position, life events, traumatic experiences, chronic adverse working and living conditions

3 The example of depression

4 The two clinical diagnostical tools DSM-IV-TR: Diagnostical and Statistical Manual of Mental Disorders, 4th Edition, Text Revis ion American Psychiatric Association (APA) ICD-10: International Statistical Classif ication of Diseases and Related Health Problems, 10th Revision Word Health Organ ization (WHO)

5 Mood disorders in the DSM-IV-TR Depressive disorders Bipolar disorders Major depressive disorder Bipolar I Major depressive disorder, single episode Major depressive disorder, recurrent Bipolar II Cyclothymic disorder Mood disorder Dysthymic disorder Depressive disorder NOS

6 Mood (affective) disorders in ICD -10 Depressive episode (F32) Manic episode (F 30) Mild, Moderate, Severe episode Severe depressive episode with psychotic symptoms Bipolar affective disorder (F 31) Other depressive episodes/episode Persistent mood (affective) disorder (F 34) unspecified Cyclothymia Recurrent depressive disorder (F33) Dysthymia Current episode mild, moderate, severe Current episode with psychotic symptoms Other mood (affective) disorder (F 38) Currently in remission Unspecified mood (affective) disorder (F 39)

7 Diagnoses of Major Depression according to DSM-IV-TR For at least 2 weeks, at least 5 of the following 9 symptoms have to be present, including at least 1 of the first 2 symptoms 1. Depressed mood 2. Loss of interest 3. Increase or /decrease in appetite; weight gain or loss 4. Insomnia or hypersomnia 5. Agitated or slowed down behavior 6. Fatigue or loss of energy 7. Feelings of worthlessness or guilt 8. Problems to concentrate 9. Thoughts of suicide or death Reservation: Major Depression should not be diagnosed, if the symptoms can be explained by bereavement

8 What do we know about the prevalence of depression in the population and w here is our knowledge coming from?

9 Psykiatrifonden Her og nu har ca danskere en depression. Heraf har ca mennesker en moderat-svær depression, mens ca har en lettere depression. Ca. 15% af den danske befolkning vil på et eller andet tidspunkt i livet få en depression. Det er ca. hver sjette dansker. Kun angst og misbrug forekommer lige så hyppigt. Depression 15-20% får på et eller andet tidspunkt depressive symptomer, og ca. 2/3 får tilbagefald en eller flere gange.

10 How prevalent is Major Depression? The National Comorbidit y Survey Replication (NC S-R) in the USA (95% CI=15,1-17,3) 16, (95% CI=5,9-7,3) 6,6 12 months Lifetime 0 Sample: Household residents, age:18+, N=9090 (73% response rate) Measurement: DSM-IV Criteria of Major Depression assessed by the Composite International Diagnostic Interview (CIDI) Kessler RC et al. JAMA 2003; 289( 23):

11 How prevalent is Major Depression? A review of 27 European Studies (17 m easuring depression) 8 (Range: ) 6, months 2 0 Sample: 17 Studies from different European countries, Combined N= Different measures: Clinical interviews, questionnaires Wittchen HU & Jacobi F. European Neuropsychopharmacology 2005;15(4):

12 Lifetime-prevalence of major depression Substantial underestimation in retrospective assessment? ,4 % ,9 19,0 18,5 NCS NCS-R Dunedin NZMHS NCS NCS-R Dunedin NZMHS NCS and NCS-R: Retrospective measurement (CIDI) Dunedin Birth Cohort: Repeated measurement (Diagnostic Interview Schedule, DIS) at the age of 18, 21, 26, 32 (Response rate: 96% at age 32) NZMHS=New Zealand Mental Health Survey Moffitt et al. 2010, Psychological Medicine;40(6):

13 60 Cumulative lifetime prevalence of common mental disorders in the Dunedin Cohort % ,4 49,5 31, , Major Depression Any anxiety Generalized Anxiety Disorders Alcohol dependance Birth cohort of 1037 Children, born in 1972/1973 in Dunedin, New Zealand (91% of eligible births) Diagnostic Interiew Schedule at ages 18, 21, 26, 32 (Response rate at age 32= 96% of the 1015 study members who were still alive) Moffitt et al. 2010, Psychological Medicine;40(6):

14 Some remarks from the authors of the Dunedin study If lifetime prevalence is this high, researchers might begin to ask, what does this mean for etiological theory for the construct validity of the DSM service-delivery policy economic burden of disease public perception of the stigma of mental disorder

15 How prevalent is Major Depression? The Danish contribution to the rev iew by Wittchen & Jacobi 4 3 3,3 3,6 3, All Women Men Point-prevalence 13.2% of cases were currently treated by a doctor for nervous/mental disorders Sample: Random sample of Danish residents, age: 20-79, N=1205 (60% response rate) Measurement: DSM-IV Criteria of Major Depression assessed by the Major Depression Inventory (MDI),a self-rating scale Olsen et al. Acta Psychiatrica Scandinavica 2004;109(2):96-103

16 Prevalence of Major Depression in Denmark in 2000 according to different measures 6 5 5, ,7 2, MDI-Scale 0,18 0,09 In- and out-patients In-patients only Antidepressants Antidepressants DDD>6 months Random sample of 7378 Danish residents, age 40 or 50 Thielen et al. Acta Psychiatrica Scandinavica 2009;119(4):

17 Differential misclassification for antidepressants 2,5 2,3 2 1,5 1 1,8 1, , ,5 0 OR for women, unadjusted OR for women, adjusted for misclassificati on OR for low social class, unadjusted OR for low social class, adjusted for misclassificati on Random sample of 7378 Danish residents, age 40 or 50 Thielen et al. Acta Psychiatrica Scandinavica 2009;119(4):

18 Danish studies on risk factors of depression using different measures for depression

19 4 Adverse life events and first time hospitalization for depression in Denmark (register-based study) * 3,4 Relative Risk ,0 * * 1,7 0,8 1,0 * 2,5 2,2 * * 1,3 0 Mother suicide Father suicide Spouse suicide Mother other dead Father other dead Spouse other dead Recent divorce Recent unemployed Adjusted for age, gender, calendar time and other life events * p<0.01 Kessing LV. Psychological Medicine 2003;33(7):

20 Work-related violence (yes vs. no) and psychotropics 3,00 Cause-specific Hazard Ratio 2,00 1,00 1,38 1,74 1,05 1,05 0,00 Antidepressants Antidepressants and anxiolytics Anxiolytics Hypnotics Hazard ratios calculated by Cox regression. Adjusted for gender, age, cohabitation, education, income, social support from colleagues, social support from supervisor, influence at work, quantitative demands at wor k. Madsen IEH et al. American Journal of Epidemiology 2011;174(12):

21 Depressive symptoms, measured with a self-rating scale (MDI) and risk of longterm sickness absence Hazard ratio 3,5 3,0 2,5 2,0 How should we label the condition of those with points: Distress? Depressive symptoms? Subclinical/Subthreshold depression? Reduced psychological health? 1,5 1,0 0,5 1 1,07 1,38 * 1,54 * 1,96 * 2,32 * 0,0 0-4 (reference) Depression Adjusted for previous LTSA, socio-demographics, health behaviors, and occupational group Hjarsbech PU et al. Journal of Affective Disorders 2011;129(1-3):87-93

22 Thank you! Contact: Reiner Rugulies ( rer@nrcwe.dk)